Why Doctors Without Borders Left Somalia: Interview with Sophie Delaunay

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It was not security per se that caused the large medical aid organization Doctors Without Borders (Médecins Sans Frontières or MSF) to suddenly announce it was pulling out of Somalia last week, but the realization that a great number of their contacts “were contacts who had been either involved or supportive of the attacks against aid workers, or who had not manifested a strong willingness to defend humanitarian action, or to provide their support to MSF in these situations of crisis,” said Sophie Delaunay, Executive Director of MSF’s US branch, in this interview with the Global Observatory.

Ms. Delaunay said, “The risks have always been very high in Somalia, but as long as you feel that you have enough safeguards and you have an acceptable respect for the work you're doing; as long as you feel there is a strong acceptance and a willingness from those who claim to be the leaders in this environment to protect your work or at least to try to defend our presence, we could stay in Somalia with a high level of risk. But if these guarantees no longer exist, then it seems to us that it was impossible to stay in the country.”

A statement about the withdrawal by MSF president Dr. Unni Karunakara reads, “We have been greeted with a barrage of attacks, including abductions and the killing of 16 of our staff. There have also been an unbearably high number of threats, thefts, and other intimidating incidents.” MSF has been in Somalia continuously for 22 years.

“We are by nature a very high-risk-taking organization,” said Ms. Delaunay. “Our job is to go to the people who are in need, and to provide them assistance. Our job will never be to turn our back on these needs and these populations. It's heartbreaking for us to have to make this decision. But we are making it precisely because we consider that the level of risk is totally unacceptable at the moment for a humanitarian organization like us. So, we are very skeptical about the optimism surrounding the stability and the security in Somalia.”

When asked about the withdrawal’s impact on its Somali staff, Ms. Delaunay said, “The decision to close our program is also a decision that was guided by the willingness to diminish the threat on our national staff. Out of the 16 colleagues who have been killed in Somalia, 11 were Somali staff. So, already, our presence in Somalia was putting this staff at risk, and the decision to withdraw was actually to limit these risks to our staff by distancing them from MSF.”

“What is clear is that it is the Somali populations who are going to pay the highest price, for their leaders’ inability to provide basic health services or even to allow for humanitarian action to take place,” she said. “So, for sure, our departure is going to have a tremendous impact on the ability of the population to seek healthcare.”

The interview was conducted by Jérémie Labbé, Senior Policy Analyst, International Peace Institute.

Listen to interview (or download mp3):

Trancript:

Jérémie Labbé: I'm here today with Sophie Delaunay, executive director of the US branch of the medical organization Doctors without Borders, better known by its French acronym, MSF.

Sophie, thanks for being with us today on the Global Observatory. Last week, MSF announced the closure of its activities and its complete withdrawal from Somalia, the country where it has been present for the last 22 years, as a result of, I quote, “extreme attacks on its staff." Yet, the last security incidents that affected the organization were the killing of two MSF staff members in December 2011, and the abduction only two years ago of two of their staff, who were released last month. So, why such a decision now?

Sophie Delaunay: Why now, Jeremie? For various reasons. First, the attack against Philippe and Kace, who were assassinated in December 2011, and the kidnapping of Montserrat and Blanca, who were only released in July 2013, are not the only incidents that the organization had to face in the course of its history working in Somalia. They are the latest in a very, very long series of events. In the last 22 years, we’ve lost 16 staff, we had several abductions, but we’ve also faced a number of intimidations, threats, difficulties to access some areas, requests for taxation, etc. So, working in Somalia has been a long series of tensions and difficulties to conduct our work properly.

So why did we make this decision now? Why didn't we decide to leave in January 2012 after Philippe and Kace were assassinated? The reason why we made this decision now is that after these incidents, we had to conduct some in-depth evaluations, risk assessments in the organization. It takes time.

Also, it is through the release of Montserrat and Blanca that we’ve been able to understand even further the conditions in which we work, and it's only after they were released that we were actually in a capacity to act. After Montserrat and Blanca were released, we continued to analyze the situation and try to assess the risk of maintaining a presence in Somalia. And we came to the conclusion that we were no longer in a capacity to ensure safety of our staff in these conditions. We came to the conclusion through our analysis that a great number of actors and contacts upon whom we rely in Somalia to conduct our operations were contacts who had been either involved or supportive of the attacks against aid workers, or who had not manifested a strong willingness to defend humanitarian action, or to provide their support to MSF in these situations of crisis.

The risks have always been very high in Somalia, but as long as you feel that you have enough safeguards and you have an acceptable respect for the work you're doing; as long as you feel there is a strong acceptance and a willingness from those who claim to be the leaders in this environment to protect your work or at least to try to defend our presence, we could stay in Somalia with a high level of risk. But if these guarantees no longer exist, then it seems to us that it was impossible to stay in the country. 

JL: In the press communiqué that was released last week, you mentioned that what led to this decision is the fact that the authorities with whom you have to negotiate are sometimes supportive, as you just mentioned, of attacks in general against humanitarian staff. This goes against the current discourse of the international community that—since the election of the new government—presents it as a legitimate government, showing great hope for the future of Somalia, with the security situation apparently improving. So, what is your take on this? Are you not sharing the optimism of the international community for the evolution of the situation in Somalia?

SD: Just to be clear, MSF’s role is not to comment on the political or economic situation of a country, but rather on the humanitarian situation that we observe on the ground. So, on the humanitarian side, what is very clear to us is that there are enormous needs remaining in Somalia, and that the authorities, whoever they are, are not in a capacity to provide the basic services that are necessary for the population. So in that sense, we certainly don’t share the optimism of the rest of the community—when we see the huge gaps existing in the health system.

From a security standpoint, we are also very cautious about the enthusiasm for the so-called stability in Somalia. If there was such an acceptable level of security, I don't think an organization like MSF would be would be forced to withdraw from the country. We are by nature a very high-risk-taking organization. Our job is to go to the people who are in need, and to provide them assistance. Our job will never be to turn our back on these needs and these populations. It's heartbreaking for us to have to make this decision. But we are making it precisely because we consider that the level of risk is totally unacceptable at the moment for a humanitarian organization like us. So, we are very skeptical about the optimism surrounding the stability and the security in Somalia.

JL: Still on the timing of your decision, should we see any implicit criticism of an increasing post-conflict discourse from the international community where everybody should be behind the new government? More specifically, this post-conflict discourse, as I call it, is reflected by the recent decision of the UN Security Council to integrate the UN mission in Somalia, meaning that all the work that the UN undertakes in the country, including humanitarian aid, should be under the authority of the political leadership of the UN mission’s agenda. So, is there still some room for independent and neutral humanitarian action in Somalia, and did it play a role in this decision?

SD: Clearly, what played a role in the decision is the realization that we could not rely on acceptable levels of guarantees and respect from various partners on all sides. Our concerns regarding the lack of respect are not just toward the al-Shabaab, although they are, certainly. As soon as we had announced our withdrawal, they took over two MSF hospitals, and they sent the patients away before they had finished their treatment. So, this is a clear disregard of humanitarian aid.

The government of Somalia, also, after arresting and convicting the person who had assassinated our two workers, and convicting him for 30 years, released this person after three months. This person walks free in Mogadishu at this moment. It is a clear signal of a lack of respect for humanitarian aid and the necessary presence of humanitarian agencies. At every level, we have experienced some disregard about our work and our presence. So clearly, we will always try to distance ourselves from a political agenda. We don't want to be forced to engage in such an agenda, but what matters to us the most is to be able to conduct impartial care; and in these circumstances we are in no capacity to do so.

JL: You mentioned before that MSF is a high-risk-taking organization, which is actually known to be the last one to stay in a high security context. Aren't you afraid that this decision to withdraw will affect organizations, and that we might see some other humanitarian organizations present in the country just back out their people behind you?

SD: I'm sure that every organization present in the country is already on the day-to-day basis questioning their presence. We've been doing so for many years because the level of risk is so high. So it's for each organization to decide where is their red line. It’s not for MSF to dictate—although we acknowledge we might influence some choices, but it's not for us to dictate whether aid organizations should stay or not. I even wish actually that some organizations would consider they have sufficient levels of protection or guarantees to continue providing assistance in the country.

What is clear is that it is the Somali populations who are going to pay the highest price, for their leaders’ inability to provide basic health services or even to allow for humanitarian action to take place. In Mogadishu alone, MSF runs the only pediatric intensive care in the city. In other regions of Somalia, in Jowhar, women will have nowhere to go for a C-section if they face a complicated delivery. So this is to say we never claimed to fill all the needs in Somalia, certainly not; unfortunately, there were many gaps remaining. But in most of the regions where we work, we were the only care provider. So, for sure our departure is going to have a tremendous impact on the ability of the population to seek healthcare.

JL: In this regard, have you taken any measures before actually implementing this decision in order to alleviate this impact, such as coordinating with organizations present in the country to take over some of your activities? What are any such measures taken?

SD: Before making the decision public, we unfortunately could not do a lot with reaching out to other organizations because the issue was so sensitive and there was so much security risk at stake that we needed to keep this decision as confidential as possible until it was very, very clear… until we had organized the safe repatriation of our team, per se. However, now that it has been announced, for sure we are working around the clock to ensure the smoothest possible handover or closure of the program.

So, to give you an example, we are going to try to complete the patients’ treatment and we’ll leave our clinics open until the patients who have to complete their treatment have completed. We will stop admitting new patients in the meantime. Also, when possible, we will hand over activities to other organizations if they're willing to and able to do so. But keep in mind that in Somalia if there was potential for additional actors, resources and action, it would have taken place already—because already MSF was not covering all the needs. So we are not so optimistic that our services and the quality of our medical services will remain after we leave our programs.

JL: You mentioned the risks, that you’re fearing reprisals against your staff; you mentioned the measures you took to evacuate or repatriate some of this staff. I heard that you have 1,500 national staff who are still present in the country—who might bear the brunt of this decision, and whom you cannot repatriate. So what's your take on this, and are there any measures you could take to try to alleviate those risks vis-à-vis the national staff?

SD: The decision to close our program is also a decision that was guided by the willingness to diminish the threat on our national staff. Out of the 16 colleagues who have been killed in Somalia, 11 were Somali staff. So, already our presence in Somalia was putting this staff at risk, and the decision to withdraw was actually to limit these risks to our staff by distancing them from MSF. So, it's a difficult decision, it's heartbreaking.

It is also a concern for us—the security of our staff; the fact that they will be without a job when MSF closes its programs. I think that a lot of them will have learned a lot from MSF and they will be willing to continue this kind of work and they will get opportunities to work with other organizations. Some of our staff have been trained with MSF and may be willing to continue with us in another capacity, in other programs outside of Somalia, and we will definitely welcome them, and try to keep this staff as much as possible. This is how we are trying to organize this transition.

JL: And to conclude, what would be the conditions for a potential return of MSF to Somalia?

SD: The conditions for a return to Somalia would be reassurances that the persons we rely on for our security and stability… for the control, lets say, of the areas where we work, are leaders who welcome and understand our presence, and are ready to try their best to ensure some acceptable work conditions for us. So, this would be the main condition.

In every country where we are working there is a high level of risk. We know that Somalia is going to remain unstable for some time. And this is not what makes us stay out of Somalia. What would make us come back, however, would be that given the high-level risk we were able to get satisfactory guarantees from our contacts there.

JL: Sophie, thank you very much for being with us today.

About the photo: A patient is carried to a ward by stretcher in Guri-el Hospital, Somalia, 2011. (©Peter Casaer/MSF)



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